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The Roles of Therapeutic Alliance and Negative Cognitions in Parent-Led Treatment Versus Standard Care Therapy for Posttraumatic Stress

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Abstract

Background

Therapeutic alliance and decreases in negative cognitions may play an important role in the outcomes of child trauma-focused cognitive behavioral therapy. However, understanding alliance from multiple perspectives (i.e., therapist, parent, and child) and if changes in negative cognitions differ by type of delivery is limited.

Objective

The current study examined therapist, parent and child therapeutic alliance and child negative cognition changes over time and as potential mediators of outcomes between Step One, a parent-led therapist-assisted cognitive behavioral therapy (CBT), and therapist-led Trauma-Focused CBT (TF-CBT).

Methods

Therapist, parent and child therapeutic alliance, child negative cognitions, child posttraumatic stress symptoms (PTSS) and impairment were assessed at the first session, mid-treatment and near the end of treatment among child-parent dyads in Step One (n = 43) and TF-CBT (n = 71). Child PTSS and impairment were also assessed at post-treatment.

Results

The rate of change in therapist and parent therapeutic alliance within Step One and TF-CBT did not significantly differ. Changes over time in child alliance ratings differed with a convex curve for Step One and a concave curve for TF-CBT children. Similar decreases in negative cognitions in Step One and TF-CBT children occurred. Neither therapeutic alliance (therapist, parent, and child) nor negative cognitions were mediators of PTSS and impairment outcomes. Therapist therapeutic alliance over time, across treatments was a predictor of child PTSS.

Conclusions

Change rates in child therapeutic alliance differs with a parent-led therapist-assisted treatment versus TF-CBT. Therapist alliance may influence child PTSS outcomes in a parent-led and therapist-led CBT treatment.

Clinical Trial Registration Information

Stepped Care for Children after Trauma: Optimizing Treatment: https://clinicaltrials.gov: NCT02537678.

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Data Availability

Data used in preparation of this article reside in the National Institute of Mental Health (NIMH) Data Archive (NDA). NDA is a collaborative informatics system created by the National Institutes of Health to provide a national resource to support and accelerate research in mental health. For demographics and the primary outcomes see Dataset identifier(s): NIMH Data Archive Digital Object Identifier (DOI: https://doi.org/10.15154/1520865). This manuscript reflects the views of the authors and may not reflect the opinions or views of the NIH. Given that the ethical committees agree, additional data used in the current study are available on reasonable request from the principle investigator of the study.

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Acknowledgements

The Crisis Center of Tampa Bay, Tanya K. Murphy, MD and Wei Wang, PhD are gratefully acknowledged, as are the children and families who participated in this clinical trial and the community agencies and therapists. Special acknowledgement to Stephanie Evans, LCSW, Jessica Turpin, MPH, Zoe Blair-Andrews, BA, Yuan Xu, MPH, and Victoria Swaidan, MSPH for their assistance with this project. A special thank you to Drs. Judith A. Cohen and Michael Scheeringa for serving as consultants on the clinical treatment and for their contributions to the development of Stepped Care CBT for Children after Trauma.

Funding

The study was supported by a National Institute of Mental Health (NIMH) award assigned to Alison Salloum (R01MH107522) and the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number P50HD103555 for use of the Clinical and Translational and Preclinical-Clinical Core facilities. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or National Institutes of Health.

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Authors and Affiliations

  1. School of Social Work, University of South Florida, 13301 Bruce B Downs Blvd, MHC 1400, Tampa, FL, 33612-3807, USA

    Alison Salloum

  2. The Study Design and Data Analysis Center, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd., MDC 56, Tampa, FL, 33612, USA

    Yuanyuan Lu & Henian Chen

  3. University of California, 3505 Pritzker Hall, Los Angeles, 90095, USA

    Aileen Echiverri-Cohen & Allison V. Metts

  4. Department of Psychology, University of South Florida, University of South Florida, 4202 E. Fowler Ave., PCD 4118G, Tampa, FL, 33620, USA

    Kristen Salomon

  5. Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Suite 4-400, Houston, TX, 77030, USA

    Eric A. Storch

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  1. Alison Salloum
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Contributions

Alison Salloum receives grant support from NIMH, The Norwegian Centre for Violence and Traumatic Stress Studies, Department of Education, Office of Special Education and Rehabilitative Services and royalties from Taylor and Francis. Further, Dr. Salloum is a developer of Step** Together for Children after Trauma treatment manual used in Stepped Care CBT for Children after Trauma. Dr. Salloum is also a national trainer for TF-CBT. Yuanyuan Lu - none. Aileen Echiverri-Cohen: none. Allison V. Metts: none. Kristen Salomon: none. Henian Chen receives grant support from NIH (NCI, NIMH, and NICHD), and Florida Department of Health. Eric A. Storch receives grant support from NIH, the Ream Foundation, Greater Houston Community Foundation, International OCD Foundation, and Texas Higher Education Coordinating Board. He receives book royalties from Elsevier, Springer, American Psychological Association, Jessica Kingsley, Oxford, and Lawrence Erlbaum. He was a consultant for Levo Therapeutics, Brainsway, and Biohaven. He owns stock in Limbix and NView. He co-founded/owns Rethinking Behavioral Health, which is a behavioral health consulting group.

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Correspondence to Alison Salloum.

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Credit Author Statement

Alison Salloum: conceptualization, methodology, investigation; Writing - Original Draft; funding acquisition; Writing - Review & Editing.

Yuanyuan Lu: formal analysis; Writing - Original Draft; Writing - Review & Editing.

Aileen Echiverri-Cohen: methodology; Writing - Original Draft; Writing - Review & Editing.

Allison V. Metts: methodology; Writing - Original Draft; Writing - Review & Editing.

Kristen Salomon: Writing - Review & Editing.

Henian Chen: formal analysis; Supervision; Writing - Review & Editing.

Eric A. Storch: methodology, investigation; Writing - Review & Editing.

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Salloum, A., Lu, Y., Echiverri-Cohen, A. et al. The Roles of Therapeutic Alliance and Negative Cognitions in Parent-Led Treatment Versus Standard Care Therapy for Posttraumatic Stress. Child Youth Care Forum 53, 801–823 (2024). https://doi.org/10.1007/s10566-023-09774-5

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